In-Clinic Assessment of Organ Doses for Interventional Fluoroscopic Procedures Project Summary / Abstract Interventional fluoroscopy uses ionizing radiation to guide small instruments such as catheters through blood vessels or other body pathways. The technique represents a tremendous advantage over invasive surgical procedures, as it requires only a small incision, thus reducing the risk of infection and providing for shorter recovery times in comparison to surgical alternatives. The growing use and increasing complexity of interventional fluoroscopic procedures, however, has resulted in public health concerns regarding both deterministic risks of skin damage and, particularly for younger patients, stochastic cancer risks to irradiated tissues and organs. Tracking and documenting patient-specific skin and internal organ dose has been specifically identified for interventional fluoroscopy where extended irradiation times, multiple projections, and repeat procedures can lead to some of the largest doses encountered in radiology / cardiology. Furthermore, in-procedure knowledge of localized skin doses can be of significant clinical importance to managing patient risk. In this research project, two recent and innovative developments will make individualized dose monitoring in interventional fluoroscopy a clinical reality. The first is the development of a library of patient-dependent hybrid computational phantoms that cover a range of body shapes and sizes within the US adult population. The second is the release of the new DICOM Radiation Dose Structured Report (RDSR) which has the potential for near real-time documentation of all factors required for reconstruction of skin and internal organ dose. The project will be organized along the following Specific Aims: Aim 1 - Establish reference irradiation fields for a range of high-dose and/or high-frequency interventional procedures through a statistical review of patient RDSR files recorded at the University of Florida's Department of Radiology. Aim 2 - Use these reference fields to establish a rich library of organ doses per unit air kerma (dose conversion coefficients, DCC) across the entire UF adult phantom series. Aim 3 - Develop software to permit individualized assessment of local skin dose. Skin dose mapping will be displayed in 3D and will make use of both reference-point air kerma values and computational hybrid phantoms individually matched to the patient's body size and shape. Aim 4 - Migrate the dose coefficient library and skin dose mapping system to make use of near real-time generation of the DICOM RDSR. The system will be tested on the new Siemens Artis Zee fluoroscopic system. The proposed aims will thus provide for patient dose monitoring in interventional fluoroscopic procedures that uniquely accounts for both the anatomical diversity of the patient population, and the complex, dynamic, and individually unique nature of these procedures. PUBLIC HEALTH RELEVANCE: In-Clinic Assessment of Organ Doses for Interventional Fluoroscopic Procedures Project Narrative Interventional fluoroscopic procedures are an alternative to invasive surgery whereby ionizing radiation is used to guide catheters and other small instruments through blood vessels and other body pathways to sites of surgical interest. The growing use and increasing complexity of interventional fluoroscopic procedures, however, has raised public health concerns regarding radiation exposure to both the patient's skin (deterministic risks) and to internal radiosensitive organs such as the bone marrow (stochastic cancer risk). In this project, innovative patient-dependent computational models of the human body, and newly available exam files of the radiation fields projected upon the patient will be coupled in a novel way to provide near real-time reporting of skin doses and post-procedure reporting of organ doses, thus allowing the physician to better manage patient risk.